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NPI Code Detail

MEDICARE: MR. ALAN GREGORY BAGSHAW LCSW, LCAS

MEDICARE:  MR. ALAN GREGORY BAGSHAW  LCSW, LCAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLCAS-24956NC
2101YA0400XAddiction (Substance Use Disorder) Counselor
31041C0700XClinical Social WorkerP014395NC
41041C0700XClinical Social WorkerCO15083NC

General Provider Information

NPI Number : 1538432737
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALAN GREGORY BAGSHAW LCSW, LCAS
Provider Business Mailing Address
First Line : 1022 N MAIN ST
Second Line :
City : MOUNT AIRY
State : NC
Zip : 27030-3636
Country : US
Telephone Number : 336-909-0192
Fax Number :
Provider Business Practice Location Address
First Line : 200 N MAIN ST
Second Line :
City : MOUNT AIRY
State : NC
Zip : 27030-3810
Country : US
Telephone Number : 336-909-0192
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2012
Last Update Date : 09/25/2023

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